| NPI | 1245366749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: NC 2012-00986) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 57.008379) |
| 208100000X Physical Medicine & Rehabilitation (Licence: TX N3431) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: CT 046226) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: MD D0066820) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: FL ME 102314) | |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2014-03-14 |